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General NPI Number Information
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NPI Number | 1962059188
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Entity Type | Individual
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Provider Name | NOAH CHARLES VENABLES PHD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 6800 FRANCE AVENUE SOUTH SUITE 300
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 612-276-2628
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Fax | 855-702-2517
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Provider Business Mailing Address
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Address Line | 13570 GROVE DR STE 130
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4400
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Country | US
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Telephone | 612-612-2728
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Fax | 855-702-2517
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6818
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License Number State | MN
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